Week 4 and Some Final Thoughts…

Feels nice to be home! After settling down for a couple of days I’ve had the opportunity to do some reflecting about the trip and the my experiences. Firstly, the travel and the Ecuadorian landscape is amazing! Definitely beyond any of my expectations.  The spanish classes were helpful also, I know more now that I did before I left. The healthcare experience was also interesting.  It many ways the hospitals and clinics in Quito looked very similar to the facilities I’ve seen in the states. When I was in Ghana several years ago, I saw a marked difference between their healthcare delivery and a dramatic lack of resources and infrastructure.  Healthcare in Quito had many aspects and was riddled with politics and that seemed to be brought up by most of the healthcare professionals that we interacted with. Like I mentioned before, the healthcare payment and malpractice changes brought about by President Correa.  With the new healthcare changes all Ecuadorians that go to the government clinics can receive care regardless of whether they can afford it.  Ecuador has around 15 million people and less than 5 million people have insurance so this health care change really helps many people.  When individuals go to the government clinics all components of the visit is free. Women that want contraception can received free implanon or IUDs and they can also potentially receive free medications if they have them in stock. Their list of medications is limited but in a country where 2/3’s of the population is uninsured and cannot afford healthcare I felt this was a step in the right direction.

View from the top of Pinchincha Volcano
View from the top of Pinchincha Volcano
During a presentation, I asked another physician their opinion on why the teenage pregnancy rate was so high and the condom use so low. She used this word “machismo” and from her description/explanation I took this to mean, the male dominated culture and the idea that children and procreation was a sign of power and virility.  In addition to this, she stated that men are just not interested in family planning (even though it is offered for free to all people by the government). We had one patient in the family medicine clinic that was 34yo and had 8 children ages 16 to 5 months.  The appointment was actually for the women’s daughter (who had extensive and neglected medical problems), but the family doc did a decent job of trying to educate the mother and get her back for family planning with OB/Gyn during the daughters appointment.  Visits with multiple complaints and lack of follow-up is a common problem in Ecuador as well as the US. The particular clinic that I spent my time in was more similar to an urgent care than a traditional family med clinic.
Posing with the Llamas
Posing with the Llamas
Additionally, I heard from several people about the influx of Cuban doctors and how they were “bad” or “used to be okay until now.” I guess Castro started a program in which individuals (from any country) can go to medical school in Cuba for free if they promise to work in an undeserved community in Cuba or their respective country. I guess to help with the shortage of primary care doctors especially in the rural areas (the same type of problem we have in the states) many Cuban doctors have been immigrating to Ecuador to help.  Oddly enough, it seems as though some in the healthcare community have less than open arms to these physicians. There are two sides to every story, but I usually find it problematic to make broad sweeping characterizations of groups of people especially when you’re presenting to a group of medical professionals from another country…
Meeting the Shaman
Meeting the Shaman
Back to the increase in malpractice punishment for physicians… When I was in the Amazon before I traveled to Quito, we had the opportunity to meet with a Shaman and hear about the traditional customs, etc. I am all for holistic, homeopathic and integrative medicine, but I think the particular Shaman we met, was perhaps less substantive and more for show. I understood enough of his discussion to realize the gaps and discrepancies in his story, but nonetheless, some Ecuadorians utilize Shamans often and in many cases prefer their traditional treatment to Western medicine.
Basilica in Quito
Basilica in Quito
During the final week I was able to spend time in a family medicine clinic. This clinic is also a part of the ministry of health.  Most of the complaints in the clinic were the usual problems – colds and other ailments that required conservative management. At least with this doctor, it was nice to see that he did not prescribe antibiotics unnecessarily. We were told with the increased malpractice laws that doctors were starting to practice more defensive medicine and were also turning away complicated patients and surgeries in order to decrease the risk of potential lawsuits.
Over all this trip was a great experience.  Some aspects were a little unorganized once I finally made it to Quito, but that’s a part of traveling with any program, you learn to roll with the punches. I will be a family medicine resident in a couple months and I am grateful for the additional Spanish and the opportunity to learn more about a culture different from my own. I’ve always been committed to helping underserved populations and expanding my worldview and through this program I was able to do both!